10-348 ASF_SummerFall2010:10-348 AAAASF 9/16/10 9:19 AM Page 1
Asf souRce - suMMeR/fAll 2010
Latex Allergy –
Prevention and Treatment
Richard Greco, M.D.
Prevention is always better than treatment. today, 3 to 6% of patients are
found to be allergic to certain proteins
found in latex. during recent years
most patients have increased their environmental exposure to latex. Many
health care workers have become allergic or sensitive to latex products
because of occupational exposure to
latex in the work environment.
careful questioning of your patient’s
reaction to the latex in their underwear,
reaction to gloves in the dental office,
restaurant modifications and any history of actual allergic reaction to latex
can be obtained during the preoperative assessment and alert you to potential problems during the surgical procedure.
All members of the operating room
team should be aware of equipment in
the facility that contains latex.
Personnel should also be alert to signs,
symptoms, and treatment of a latex
reaction. latex product use should be
avoided in patients with a significant
history of latex reactions or individuals
that alter their lifestyle due to a latex
allergy.
Patients who experience a latex reaction undergoing procedures with local
anesthesia will often complain of itching, growing rash, watery eyes, sneezing and early signs of upper airway
obstruction secondary to edema. the
best treatment includes removing all
latex from contact with the patient, irrigating the area with copious amount of
water, intravenous benadryl and
steroids. if the symptoms abate, one can
proceed with latex-free equipment.
Allergic reactions are often difficult to
determine, when utilizing general or
deep sedation anesthesia, because
patients cannot complain of itching,
and their rashes are often hidden from
sight because of the surgical drapes.
the first symptoms may be an unexplained drop of blood pressure, bronchospasm, hypoxemia, or a full-blown
anaphylaxis reaction.
if a latex reaction does occur during a
surgical procedure, the operating team
continued on page 10...
latex Allergy-Prevention/treatment... 1
the AAAAsf board........................... 2
cMs deeming Authority Approval.... 3
legislative update............................ 4
AAAAsf President’s Message............ 5
AAAAsf international expands......... 7
Malignant hyperthermia................... 8
Anesthesia shortages continue......... 11
newly Accredited facilities.............. 12
surgical safety checklist................... 14
news you can use, fee schedule.....16
A PublicAtion of the AMeRicAn
AssociAtion foR AccReditAtion of
AMbulAtoRy suRgeRy fAcilities, inc.
www.aaaasf.org
10-348 ASF_SummerFall2010:10-348 AAAASF 9/16/10 9:20 AM Page 2
american association for accreditation of
ambulatory surgery facilities, Inc.
Board Members 2010
EXECUTIVE CoMMITTEE
President - lAWRence s. Reed, M.d.
Vice President - hARlAn PollocK, M.d.
secretary/treasurer - geoffRey R. Keyes, M.d.
Past President - AlAn h. gold, M.d.
VP of education - RichARd d'AMico, M.d.
VP of standards - RichARd gReco, M.d.
DIrECTors
gary brownstein, M.d.
bonnie g. denholm, Rn, Ms, cnoR
Ronald e. iverson, M.d.
John newkirk, M.d., Phd
Jennifer K. Quicci, cRnA, Ms
darrell Ranum, Mth, esq.
edward s.truppman, M.d.
hector Vila, M.d.
david c. Watts, M.d.
®
®
TrUsTEEs
gustavo colon, M.d.
daniel Morello, M.d.
Robert singer, M.d.
James A. yates, M.d.
Michael f. Mcguire, M.d.
Jeff Pearcy, MPA, cAe, executive director
asf Editor
Richard J. greco, M.d.
Publications committee chairman
asf Design/Production Director
Jaime trevino - Marketing/communications director
the Asf source is published on a tri-annual basis.
contributions to the Asf source are welcome, but
may be edited for clarity and placement purposes.
All rights reserved. no part of this publication may be
reproduced, stored in a retrieval system, or transmitted in
any form or by any means, electronic, electrostatic, magnetic tape, photocopying, recording, or otherwise, without
the full written permission from the publisher.
the opinions expressed within are those of the contributors to the Asf source and do not necessarily reflect the
opinions or views of the AAAAsf.
aaaasf Mission statement: it is the mission of
the Association to develop and implement standards
of excellence for quality patient care through an accreditation system for ambulatory surgery facilities and to serve
the public interest by providing accurate and timely information regarding surgery in ambulatory surgery facilities
and Ascs.
2
aaaasf
Patient safety
Brochure
order form
$35 (Pkg. of 25)
$100 (Pkg. of 100)
Quantity ________
total cost $_________
View the brochure on line:
www.aaaasf.org/ps.pdf
facility name___________________________________________________
Address________________________________________________________
city___________________________________state______Zip____________
name on credit card_____________________________________________
credit card#____________________________________________________
exp. date_________signature______________________________________
faxes must include a credit card number (Visa, Mastercard, or American
express), the card expiration date and signature to authorize the charge
amount shown on the order form.
MaIL: aaaasf, PoBoX 9500, gurnee, IL 60031 faX: 847-775-1985
10-348 ASF_SummerFall2010:10-348 AAAASF 9/16/10 9:20 AM Page 3
CMS Approves AAAASF As Deeming Authority
on August 20, 2010 cMs posted in the
federal Register their approval of the
American Association for Accreditation
of Ambulatory surgery facilities, inc. for
continued deeming Authority for
Ambulatory surgical centers (Ascs).
cMs’ final notice announces its decision to approve without condition the
American Association for Accreditation
of Ambulatory surgery facilities
(AAAAsf) request for continued recognition as a national accreditation program for ambulatory surgical centers
(Ascs) seeking to participate in the
Medicare or Medicaid programs.
cMs conducted a comparison of
AAAAsf’s accreditation requirements
for Ascs to current Medicare conditions
for coverage (cfcs) as outlined in the
state operations Manual (soM). they
also conducted a corporate onsite visit
and survey observation to validate proper application of the requirements.
the cMs review and evaluations of
AAAAsf’s deeming application yielded
the following:
• AAAAsf’s survey files were complete,
accurate, and consistent with the
requirements at § 488.6(a).
• AAAAsf’s data submissions are
accurate, complete and timely in
accordance with the requirements at
§ 488.4(b).
• AAAAsf revised its accreditation
decision letters to ensure they are
accurate and contain all of the elements
necessary for the Regional office to
render a decision regarding the deemed
status of an accredited Asc.
• AAAAsf revised its policies to
require its surveyors to use the surveyor
tools thus ensuring accurate and
complete survey files.
• AAAAsf developed surveyor’s tools
to include a medical record review
sheet, personnel review sheet, and policy review to assist surveyors with accurate and complete documentation.
• to meet the Medicare requirements
related to unannounced surveys at
2700A of the soM, AAAAsf modified
its policies related to the survey window in which organizations could
receive an accreditation survey for
deemed status.
• to meet the survey process requirements in Appendix l of the soM,
AAAAsf developed a policy outlining
the minimum number of medical
records that must be reviewed during a
certification survey.
• to meet the requirements at soM
2200f, AAAAsf revised its policies and
procedures to ensure the documentation of
deficiencies contains a regulatory reference, a clear and detailed description of
the deficient practice, and relevant finding.
life safety code surveys.
• to ensure its surveyors were adequately trained, AAAAsf developed
a website where surveyors could access
a resource library of training webinars,
interpretative guidelines, principles of
documentation, standards, surveyor
handbook, survey forms and other
materials to assist surveyors in the field.
Based on the review and observations, CMS has determined that
AAAASF’s accreditation program for
ASCs meets or exceeds CMS’
requirements...
therefore, they have approved, without
condition, AAAAsf as a national
accreditation organization for Ascs that
request participation in the Medicare
program, effective november 27, 2009
through november 27, 2012.
• to meet the requirements at 2728 of
the soM, AAAAsf modified its policies
regarding timeframes for sending and
receiving a plan of correction (Poc) for
3
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AAAASF Legislative Update
Thomas S. Terranova, M.A., Director of Legislative and External Relations
the texas office based surgery and Ambulatory surgery center rules have, for some time, included AAAAsf as an approved
accreditation organization. however, the application for Asc licensure has not always included AAAAsf as one of the named
accreditation organizations on the form. the department of state health services recently revised the application form to
accurately reflect the Asc rules in texas as including AAAAsf as part of the licensing regime.
florida’s boards of Medicine & osteopathic Medicine continue to develop joint rules for the practice of Pain Management. the
Joint committee has scheduled a meeting for september 10, 2010 in orlando. the meeting will define which accrediting
agencies will be capable of performing inspections that exempt pain clinics from a state inspection.
in illinois, the Worker’s compensation commission has filed emergency rules on July 6, 2010 to expand reimbursement of
facility fees for procedures performed in accredited facilities. the language of the rules is currently under negotiation with
interested parties and the rules are under review with the illinois Joint committee on Administrative Rules. the emergency
rules are currently in effect temporarily and are in the process of being made permanent.
the state of Washington Medical Quality Assurance commission (MQAc) has filed new rules for the use of anesthesia in office
based settings that go into effect on september 2, 2010. the rules require that outpatient settings that provide surgical and
medical services utilizing moderate sedation or analgesia, deep sedation or analgesia, or major conduction anesthesia,
become accredited within 365 days of the effective date of the rules. the rules stipulate that the office based surgery (obs)
practices be accredited by one of the three nationally recognized accrediting organizations.
As states continue to develop new and evolving requirements for office based Practices and Ascs, AAAAsf will remain diligent in monitoring new regulations and providing expertise to the process. despite this organization’s commitment to assisting
responsible oversight efforts, individual physicians and facilities remain the most valuable resource in identifying critical issues
requiring attention. AAAAsf would like to encourage facilities to continue to be vigilant and to alert AAAAsf upon learning of
new or developing requirements. Please email me at: [email protected] or call me at 888-545-5222.
Visit the AAAASF website for Legislative Updates and News, www.aaaasf.org
Take the Facility Fee Survey
the American Association for Accreditation of Ambulatory surgery facilities (AAAAsf) remains committed to the advancement of patient safety and quality of care in outpatient settings. over the years, however, it has become apparent that private insurers and government reimbursement authorities do not uniformly recognize accreditation as sufficient to qualify for
reimbursement. Many in the AAAAsf membership have voiced concerns with the current arrangement and have asked for
information on the topic of reimbursement for covered procedures. to that end, AAAAsf is seeking to compile information
on the frequency of facility fee payments to accredited facilities for covered procedures.
if you are receiving facility fees, please take a few moments to answer this short survey to help AAAAsf better understand
the way that payors treat procedures conducted in accredited facilities. the data from this survey will allow AAAAsf to
work towards universal recognition of the accredited facility as a locus for high quality health procedures to be treated
equally with other provider types.
To take the survey, visit: http://www.zoomerang.com/survey/wEB22B6a736XYN
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AAAASF President’s Message
in october, i turn over the presidency of
AAAAsf to the very capable and deserving
hands of dr. harlan Pollack of dallas, texas. he
and i have worked together very closely over the
past year, so he is well prepared and ready to
assume this role.
i have thoroughly enjoyed my two year stint as
president of AAAAsf. i am extremely proud of
all that we have achieved during my tenure and
of all the projects which are currently in various
stages of development and completion.
imagine at the time. for over twenty years
AAAAsf was run by a management company.
As with all business decisions, this one had
attendant risks associated with it. i am delighted to say, that even in the tough economic
times in which we now live, AAAAsf is flourishing. the board envisioned an association
that could spread throughout many disciplines
beyond plastic surgery and one that included
global expansion. this is no longer strategic
planning, but reality.
At this time, i must also single out the amazing
We are moving forward in finalizing our position LawrENCE s. rEED, M.D. efforts of our international division under the
PresidenT
with the Rural health clinics and the
leadership of dr. Ron iverson. AAAAsfi now
Rehabilitation Agencies programs. Working
has over 30 accredited clinics in six countries
closely with members of the new york state society of oral
with tremendous progress in costa Rica.
and Maxillofacial surgeons, we have developed a focused
standards manual for their specialty as they move towards
We find ourselves as a leader in gastroenterology accreditawidespread accreditation of their numerous facilities.
tion with significant gains across a multitude of disciplines.
We are growing our business and enhancing our presence in
the number of facilities accredited by AAAAsf has
the industry. AAAAsf is staged to become the ”go to”
increased dramatically to over 1400, representing a 57%
accreditation association in healthcare.
increase from 2008. the offices and Ascs which we accredit represent a wide range of medical/dental specialties.
none of this would have been possible without the invaluable efforts of our board members, the chairmen of our comour well-established Medicare program has been finely
mittees, their hard working committee members and our
tuned to comply with the new and more stringent cMs stanexecutive committee. but in a larger sense, the anchor of
dards and requirements. these enhancements have made
this organization is our incredible executive staff under the
our program better while improving our administration and
inimitable and skillful leadership of our executive President,
oversight of the program.
Jeff Pearcy. it is safe to say that none of this could have been
achieved without their efforts, their incredibly hard work
having received our final approval from the cMs to continand their unswerving loyalty to our association and its prinue as deeming authorities for Ascs seeking participation in
ciples. i must thank Pamela baker, theresa Rossi, Jaime
the Medicare program, we are on the verge of instituting
trevino, tom terranova, Jerome unger, charlene Martinez,
similar policies to enhance our regular accreditation proJeanne henry, Adriana lomeli, chrissy deal, lindsey Perez
gram which will mirror the improvements accomplished by
and sonja Richardson for their tireless efforts and good will.
the cMs review. the establishment of a more robust QA
committee to systematically monitor and evaluate our
i would like to now give a special thank you to Jeff Pearcy
inspector’s program reflects many methods and policies
with whom i have worked hand in hand and shoulder to
established by the cMs review of our Medicare program.
shoulder throughout these two years. it is a relationship that
this new system of evaluation will make us a better organii will always treasure. Jeff is a superb leader and valued colzation and provide us with better data to make important
league in arms. countless hours a week were spent meeting
decisions concerning education and administration.
the challenges, developing strategies, and selecting the right
roads to take, but always with a common goal in mind...that
in the early part of this decade, the AAAAsf board made an
which is the best for AAAAsf.
aggressive decision to open a new corporate office in order
to expand our accreditation program in ways we could only
thank you Jeff, for a exciting and wonderful two years.
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AAAASF Launches New Surveyor Website
Theresa Griffin-Rossi, CAE
Director of Education
lawrence Reed, M.d., AAAAsf
President and david Watts, M.d.,
AAAAsf education committee chair
are pleased to announce the launch
of a new surveyor’s website. the
website was developed to help Quad
A surveyors maintain certification
and provide information critical to
performing high quality surveys.
surveyors will now have access to
survey resources for all AAAAsf
accreditation programs from their
computers in “real time.” in Phase
two of the website development,
surveyors will be able to log on to
access their individual homepage to
use interactive tools to review
upcoming survey assignments and
track continuing education segments
to maintain certification.
“At every surveyor training session
we ask participants to give us feedback on the quality of our current
training components and comment
on how Quad A can better support
the surveyors to assist them throughout the survey process. the pertinent
information gathered on the training
evaluation is summarized and developed into recommendations by the education committee that is presented to the
Quad A board of directors. the board has been very responsive to numerous surveyor requests and the genesis of the
surveyor website is one of many projects born of those recommendations. in the near future, the website has great
potential to transform the way survey findings are processed and reported back to the central office from surveyors out
in the field. We continue to look at innovative ways to make the entire surveyor certification and survey process more
comprehensive and seamless,” stated david c. Watts, M.d., education committee chair.
Another feature of the surveyor website is an alert function on the home page. surveyors should check the site frequently for alert notifications and updates on standards or survey procedural changes and other updates essential to the
survey process. time sensitive updates are also delivered to surveyors via e-blast to ensure timely dissemination of pertinent changes to the program.
Visit the surveyor website at www.aaaasfsurveyors.org. this site is a work in progress that will continue to be developed
over the next few months. Quad A wants to incorporate the tools and resources that will best serve our surveyors. send
your comments to theresa griffin-Rossi, [email protected].
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AAAASFI Expands International Accreditation Into New Markets
Ronald Iverson, MD President of SFR
surgery facilities Resources, inc. (sfR) is a subsidiary organization to the American Association for Accreditation of
Ambulatory surgery facilities (AAAAsf), the “gold standard”
for surgery facility accreditation in the united states. sfR was
organized in 2005 to offer a program of accreditation internationally. in 2009 the sfR international accreditation program
was renamed AAAAsfi (AAAAsf international) by the board
of directors of sfR.
the AAAAsfi name best represents who sfR is in international accreditation.
there is significant interest in accreditation in latin American countries, especially
costa Rica. currently, there are 40 AAAAsfi accredited surgery facilities worldwide of
which belgium, serbia, south Africa, Australia, finland and costa Rica are represented. for a complete list of AAAAsfi accredited facilities, visit www.surgeryfacility.com.
Past President Michael Mcguire, Md, and current President of sfR, Ronald iverson,
Md have championed this program of international accreditation for the last five years
by speaking at many prestigious global conferences on healthcare and medical
tourism and inspecting surgery facilities around the world.
Recently, Jeff Pearcy, executive Vice-President of sfR, attended the latin America congress on Medical tourism in costa
Rica and spoke on a panel discussing accreditation and
patient safety. geoffrey Keyes, M.d., AAAAsf
secretary/treasurer, was a keynote presenter on the second
day of the congress (shown below), presenting the latest
study derived from the AAAAsf peer review system data. it was the only data driven presentation in the congress. the
President of Pro-Med, an international medical group and a leader in the movement to create a safe environment for medical
tourism in costa Rica, praised dr. Keyes’ presentation.
Representatives from guatemala are in the process of working with Mr. oscar Molina, the AAAAsfi latin American representative working for sfR, to discuss the development of an accreditation program that mirrors the successful program in costa
Rica. Many major guatemalan dental facilities have received our application materials in anticipation of accreditation.
AAAAsfi has developed a special set of dental standards that more closely relate to surgical practices performed in dental
clinics.
Representatives from the dominican Republic, el salvador, and columbia government agencies have received our accreditation program materials and requested that we contact them for future development. A key contact for AAAAsfi is carlos
enrique cardenas Rendon, Md, who is the director of a cluster of services for surgery and dentistry in columbia.
dr. Keyes
surgeryfacility.com or aaaasfi.org
7
Malignant Hyperthermia
MH Effects in Surgery
MH complications include a rise in heart rate, extreme temperature elevation,
muscle breakdown and changes in body chemistry that can lead to excessive
bleeding and the failure of organs and other body systems. The reaction can
occur during any part of a procedure under general anesthesia or even in the
recovery room, and in any surgical setting from office and ambulatory centers
to hospitals. It can be treated with dantrolene sodium if the case is identified
and treatment is administered very early in the onset of the condition.
Unfortunately, it is possible that some cases of malignant hyperthermia can
result in death even if proper treatment is administered.
Detecting MH
A very specialized muscle biopsy test, only available at a few institutions, is
the most accurate test for malignant hyperthermia susceptibility. However,
DNA testing can help provide answers for people who suspect they might be
at risk. You can be assured that MH is an extremely uncommon condition,
and your anesthesia professional and other surgical team members are welltrained for adverse reactions that can occur during procedures.
Patient Responsibility
To be sure you receive the highest level of care no matter what happens in
the OR, it is critical that you request an anesthesia professional’s presence for
any procedure involving anesthesia. This ensures the person giving you anesthesia is a fully trained licensed professional, and that you know you have the
most highly trained anesthesia professional at your side to manage any complications that may arise.
Prior to undergoing general anesthesia for surgery, patients concerned about
malignant hyperthermia inform their anesthesia professional of any personal
or family history of malignant hyperthermia, or adverse reactions to anesthetics. You also may ask if a supply of dantrolene is available in the facility
where surgery will take place and whether treatment protocols are also available.
MH Patient Registry
While 95 percent of patients who experience malignant hyperthermia reactions survive it, the ASA-MHAUS* partnership still needs the public’s help to
build a database of patients who are already aware they have the gene mutation that leads to malignant hyperthermia. Since its formation in 1981,
MHAUS has been working through its growing member network of patients
that are MH-susceptible and their family members, as well as anesthesia professionals and other health care providers, to educate the medical community
and the public regarding the risks MH can unexpectedly pose in conjunction
with some of the most commonly used anesthetics in hospital operating
rooms, dental offices and surgical centers.
*The American Society of Anesthesiologists (ASA)and the Malignant
Hyperthermia Association (MHAUS) of the United States have formed
a partnership to increase resources about the disorder and bring
patients together with the physicians.
For more information on MH: www.mhaus.org
8
AAAASF
Educational Foundation
“The benefits of personal involvement in educational endeavors and
supporting educational programs are measured
exponentially in relation to the amount we
choose to give.”
- Robert Singer, M.D.
Please help support the AAAASF Educational
Foundation with a charitable donation. Your
donation will help fund important educational
programs specific to the needs of surgeons and
their staff in accredited facilities.
Your donation is tax deductible.
AAAASF Educational Foundation Donation
I wish to make a donation of $________
to: the AAAASF Educational Foundation.
If donating by check, send to:
AAAASF Educational Foundation
POBOX 9500 Gurnee, IL 60031
Name:
_________________________________________
Social Security Number Or Tax ID #:
_________________________________________
Facility Name:
_________________________________________
Mailing Address:
_________________________________________
City, State and Zip:
_________________________________________
Phone: __________________________________
Fax: _____________________________________
Email Address:
_________________________________________
AAAASF Inspectors can request that all or a
portion of their $500 honorarium be donated to
The AAAASF Educational Foundation. After
completing an inspection, contact Adriana at
the AAAASF Office at: 888-545-5222.
[email protected]
10-348 ASF_SummerFall2010:10-348 AAAASF 9/16/10 9:20 AM Page 9
Online Resource Guide Provides Links to Useful Web Sites and Products
AAAAsf has created an updated online Resource guide to replace our old cd version. the new web version will allow for new
resources and products to be included more easily and outdated information can be edited faster. if you have any resource or product
that corresponds with a particular standard, or to promote a product or service, contact Jaime trevino for consideration. line listed
resource links approved for publication are included at no charge.
Paid advertising is available by contacting Jaime: 888-545-5222 or [email protected].
AAAASF RESOURCE GUIDE
This Resource Guide includes a collection of supplemental resources that may enhance an area of interest for you as you review the AAAASF Regular Standards. They are
provided as added educational information. To acheive accreditation, a facility must comply with current AAAASF Standards and abide by the strictest regulation required by
local, state , federal laws or AAAASF standard.
If you would like to submit a new resource to be considered for this guide, click here
REGULAR STANDARDS VERSION 12
These resources are current as of the posting date however, you should always search for
the most recently published guidelines issued by these organizations to ensure current
access to the most current information. AAAASF does not have any financial interest in
any of the companies that may be listed in this guide. Nor does AAAASF endorse one
company or resource over another (listed or not listed here). You are not bound to use
these companies in order to satisfy any standard nor does use of these products guarantee
compliance of the standard (one may purchase a product listed but not use it according to
manufacturer's recommendations for example). We encourage your participation in the
gathering of resources that may be valuable to the education process for others, please use
the link above to submit new resources or to report an outdated reference, link or other
i
RESOURCES
EXAMPLE
ADS
GENERAL RESOURCES
American Society of Anesthesiologists
Federation of State Medical Boards of the
520 N. Northwest Highway
United States, Inc.
Park Ridge, IL 60068-2573
PO Box 619850
telephone: (847) 825-5586
Dallas, TX 75261-9850
fax: (847) 825-1692
Main Phone: (817) 868-4000
e-mail: [email protected] Publications And
Outpatient_Surgery
Services/standards
www.aaaasf.org/pub/resourceguide.htm
to submit resource links or advertising questions: [email protected]
W
Prevent Medical Errors, Monitor And
Document Safe Surgical Practices,
Ensure Ongoing Regulatory
Compliance And Reduce Costs!
www.surgimetrix.com
888-863-8749
9
10-348 ASF_SummerFall2010:10-348 AAAASF 9/16/10 9:20 AM Page 10
Latex Allergy...From Page 1
should consider the following treatments:
1.) stop the procedure and any further contact of latex contaminated products with the patient. irrigate with copious amounts
of water.
2.) Resuscitate the patient with cardiovascular stabilization and airway control.
3.) Administer drug treatment for resuscitation and treatment of the anaphylaxis, which includes:
a. epinephrine – releases the dilation of blood pressure and relaxing the airway muscles.
b. diphenhydramine – a h 1 blocker and antihistamine – stops and reverses the effects of histamine release from
an allergic reaction.
c. Ranitidine and cimetadine – both are h 2 blockers and will reduce some of the symptoms from the histamine
released.
d. nebulized Albuterol – relieves the constriction of bronchospasm.
e. dopamine – stimulates blood vessels constriction to increase blood pressure.
f. glucocorticosteroids – reduces inflammation allergic reaction.
4.) if the patient is stabilized, change gloves and instruments to finish the surgery avoiding all latex products. if the patient does
not stabilize, continue resuscitation, close wounds and finish surgery after the patient has been stabilized.
Preoperative Patient Skin Antisepsis Course Available from AORN
here is an outline of one of AoRn's confidence-based learning Modules available
online at www.aorn.org.
Preoperative Patient skin antisepsis - 1.2 contact hours
introduction
the goal of preoperative preparation of the patient's skin is to reduce the risk of
postoperative surgical site infection by removing soil and transient microorganisms
from the skin, reduce the resident microbial count to subpathogenic levels in a short
period of time and with the least amount of tissue irritation, and inhibit rapid,
rebound growth of microorganisms.
in order to reduce the potential for a patient to develop a surgical site infection, it is
essential for perioperative personnel to be knowledgeable regarding the process of
preoperative skin preparation.
Purpose
the purpose of this activity is to provide perioperative nurses with a guideline for
achieving skin preparation of the surgical site.
objectives
* describe the methods of preparing the patient's skin to decrease risk of surgical site infection.
* identify the methods for removing soil and transient microorganisms from the skin.
* describe why reducing the resident microbial count to subpathogenic level in a short period with the least amount of
tissue irritation is critical.
* define methods for inhibiting rapid rebound growth of microorganisms.
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Some Anesthesia Shortages Continue in 2010
According to the American society of Anesthesiologists’ web site, www.asahq.org, here
is an update on succinylcholine and other drug shortages:
the AsA Washington office has been in frequent communication with the fdA regarding ongoing difficulties obtaining succinylcholine. the Agency is very aware of the situation and is working collaboratively with AsA and manufacturers to address this problem, as well as other ongoing anesthesia drug shortage issues.
According to the latest information from the fdA, sandoz, one of two manufacturers of
succinylcholin, continues to release quantities of Anectine 20mg/ml 10 ml vials. the
company is releasing quantities weekly but are not yet able to meet full demand.
hospira, the other manufacturer, did release some Quelicin vials to wholesalers and
they anticipate additional releases of 100mg/ml 10ml and 20mg/ml 10 ml vials by end
of this month. both firms have been providing regular updates to the fdA but the agency does not have an exact date yet for
when full demand will be met. the release of hospira's product at the end of the month should help the situation greatly, and
hospira plans to continue releasing product from that point on.
for the latest information on this or other drug shortages, please visit the following drug shortage websites:
food and drug Administration www.fda.gov/Drugs/Drugsafety/Drugshortages
American society of health-system Pharmacists www.ashp.org/Drugshortages/Current/
to report a drug shortage or difficulty obtaining any drug please email the fdA’s drug shortage division at:
[email protected]
According to the FdA:
when did the propofol shortage begin?
the propofol shortages began in the fall of 2009. two u.s.-based manufacturers of propofol halted distribution and recalled
several lots of propofol products because of quality problems. this action left only one company to supply propofol to the
entire united states. the two companies affected by the quality problems are working to restore full production of propofol,
which is anticipated to occur by fall 2010. this timeline is reflective of the complex and often long lead-time necessary to
manufacture sterile injectable drug products.
How is fDa addressing this shortage in the U.s. propofol supply?
fdA is working with the manufacturers of propofol products to address these shortages. fdA has temporarily allowed the
importation of fresenius Propoven 1% (propofol 1%) into the united states. Although fresenius
Propoven 1% is an unapproved drug product in the united states, it is currently approved in other
countries. fdA has determined that it is comparable to the propofol used in the united states. it is
important to note that there are some key differences in the formulation and labeling between the
u.s. marketed propofol products and the international fresenius Propoven 1%.
under specific circumstances, the fdA has the discretion to allow the importation, distribution, and
use of unapproved drugs to address severe drug shortages and public health emergencies. fdA
ensures the quality of these drugs through close inspection of the manufacturing facilities (these
companies must meet current good manufacturing practices) and thorough evaluation of available
safety and efficacy data.
www.fda.gov/Drugs/Drugsafety/Drugshortages/ucm050792.htm
11
10-348 ASF_SummerFall2010:10-348 AAAASF 9/16/10 9:20 AM Page 12
Newly Accredited Facilities
faCILITY
DIrECTor
CITY/sTaTE
CLass
sPECIaLTY
ear nose throat and Plastic surgery Associates of the south sound
nancy R. Juhlin M.d.
Puyallup, WA
c
Plastic surgery
stanley A. fox M.d.
Massapequa, ny c-M
internal Medicine
csR outpatient Medical services, llc
Park Avenue obs
david P. Rapaport M.d.
new york, ny
c
Plastic surgery
south brooklyn Medical Practice Pc
dmitry bronfman M.d.
brooklyn, ny
c-M
obstetrics & gynecology
Manalapan surgery center
brian Weiner M.d.
Manalapan, nJ
c-M
gastroenterology
lake success surgical center
Michael terrani M.d.
lake success, ny c-M
obstetrics & gynecology
stony brook Womens health site b
david shobin M.d.
huntington station, ny
c-M obstetrics & gynecology
lexington Medical group Pllc
steven e. fochios M.d.
new york, ny
c-M
gastroenterology
Joseph iwanicki Md fAcog
Joseph iwanicki M.d.
brooklyn, ny
c-M
obstetrics & gynecology
Anna Arsenous Md
Anna Arsenous M.d.
glendale, ny
c-M
Plastic surgery
sottile Megna Md Pc
daniel Megna M.d.
staten island, ny c-M
gastroenterology
Ambulatory Vascular care
Jodumutt g. bhat M.d.
new york, ny
c-M
Vascular & general surgery
Agi Medical Pllc & Well life Physician consulting, Pc
Pei ying Xiao M.d.
brooklyn, ny
c-M
gastroenterology
burton Way surgery center
Robert o. Ruder M.d.
beverly hills, cA c
Plastic surgery Within head/neck
ear nose and throat Associates of ny Pc
gary snyder M.d.
new hyde Park, ny A
Plastic surgery Within head/ neck
Reproductive center of central new Jersey eric Knochenhauer M.d. south Plainfield, nJ c-M obstetrics & gynecology
May street surgi center
steven hodes M.d.
edison, nJ
c-M
gastroenterology
Anglemeyer osteopathic family clinic
Alfred J. schlorke d.o.
nappanee, in
b
family Practice
Winston c tom Md Pc
Winston c. tom M.d.
new york, ny
c-M
gastroenterology
nyMhb fertility services Pc
george d. Kofinas M.d.
brooklyn, ny
c
obstetrics & gynecology
garden state surgery center, llc
barry e. dibernardo M.d. Montclair, nJ
c-M
Plastic surgery
Kaufman surgery center
daniel Kaufman M.d.
brooklyn, ny
c
Plastic surgery & Pediatric dentistry
Wetherington Plastic surgery center
g. Marc Wetherington M.d. Rome, gA
c
Plastic surgery
Mifflin county community surgery center
Alan gordon M.d.
lewistown, PA
c
ophthalmology
Arizona Advanced surgery center, llc
nathaniel Zoneraich M.d. scottsdale, AZ
c
Multiple-specialties
samaritan ob/gyn, inc.
stephen J. schuermann M.d. cincinnati, oh c-M
obstetrics & gynecology
Pioneer Medical care Pllc flushing 2
usha Krishnamurthy M.d. flushing, ny
c-M
gastroenterology
Popp's ferry out Patient surgery center, llc gregory e. bertucci M.d. biloxi, Ms
b
ophthalmology
Albany iVf
Peter M. horvath M.d.
Albany, ny
b
Reproductive endocrinology
Manhattan interventional Radiology
John h. Rundback M.d.
new york, ny
c
Radiology
Rockledge surgery center, inc.
thomas c. yu M.d.
bethesda, Md
A
Multi-specialty
fremont surgery center
Anmol Mahal M.d.
fremont, cA
c
Multi-specialty
Ayman farid, M.d., l.l.c.
Ayman farid M.d.
staten island, ny c-M
cardiovascular disease
West carver Medical Associates, A division of Prohealth care Associates, llP
Alan M. schuller M.d.
huntington, ny c-M
gastro
Pacific cataract and laser institute, inc. P.s. William gruzensky M.d. olympia, WA
b
ophthalmology
Ace endoscopy
david feldman M.d.
new york, ny
c-M
gastroenterology
five boroughs Medical Associates, Pc
franco gallo M.d.
Riverhead, ny
c-M
gastroenterology
lee institute of Plastic surgery
Richard K. lee M.d.
Roseville, cA
c-M
Plastic surgery
Mid hudson Medical group
stuart Weinberger M.d. Poughkeepsie, ny c
Multi-specialty
delaware Valley Plastic surgery, P.A.
evan sorokin M.d.
cherry hill, nJ
c
Plastic surgery
spring Valley surgery center, llc
godwin o. Maduka Md las Vegas, nV
c
Pain Medicine
conejo Valley surgery center
Adebambo ojuri M.d.
thousand oaks, cA c
gastroenterology
Advanced Pain Management of central ind. Randall J. franiak M.d.
carmel, in
b
Pain Medicine
Mccandless endoscopy center, llc
Katie farah M.d.
Pittsburgh, PA
c-M
gastroenterology
Whitestone Ambulatory Medical, Pllc
Medhat f. sami M.d.
Whitestone, ny b
gastroenterology
Reliant surgical center
Jamie R. Wisser M.d.
east Windsor, nJ c
Plastic & orthopedic surgery
the gynecology center
Ali behnam M.d.
cumberland, Md A
obstetrics & gynecology
12
10-348 ASF_SummerFall2010:10-348 AAAASF 9/16/10 9:21 AM Page 13
Newly Accredited Facilities
faCILITY
DIrECTor
CITY/sTaTE
CLass
sPECIaLTY
turning Pointe surgery center
Karl b. hiatt M.d.
Mesa, AZ
c
Plastic surgery
Premier Plastic surgery
James newman M.d.
Palo Alto, cA
c
Plastic surgery & otolaryngology
steven finkelstein M.d. new york, ny
b
gastroenterology
Manhattans Physician group
Plastic surgery specialists, M.d., P.c.
Robert oliver Jr., M.d.
birmingham, Al c
Plastic surgery
beverly hills south Pacific surgery center
christos Kalatzis M.d.
beverly hills, cA c
Pain Medicine, general surgery
o'neill Plastic surgery, P.A.
Patrick J. o'neill M.d.
daniel island, sc c-M
Plastic surgery
columbia nephrology Associates, P.A. Access center
Michael d. cook M.d.
columbia, sc
b
nephrology
new york Park Avenue surgery
Ramtin Kassir M.d.
new york, ny
c
otolaryngology, dermatology
boro Park surgery center
samy lasheen M.d.
brooklyn, ny
c-M
Pain Medicine
spring Valley surgery center, llc
godwin Maduka M.d.
henderson, nV c
Pain Medicine
Vascular Radiology Associates ii, llP
W. bruce tannehill M.d. Augusta, gA
b
Radiology
eastside gynecology
Ronald d. blatt M.d.
new york, ny
c-M
obstetrics & gynecology
integrated Medical Professionals, office based Procedures
carl A. olsson M.d.
north hills, ny c
urology
bend Plastic surgery
Adam P. Angeles M.d.
bend, oR
c
Plastic surgery
cARe fertility
Rudy Quintero M.d.
glendale, cA
c-M
obstetrics & gynecology
soler-baillo Plastic surgery
Jose soler-baillo M.d.
Miami, fl
c
Plastic surgery
ny surgical and Anesthesia suites, P.c.
brian haftel M.d.
bronx, ny
c-M
Pain Management, Anesthesia
Manhattan Medical Practice, P.c.
Kiran bhat M.d.
brooklyn, ny
c-M
gastroenterology
Professional Medical services of Westchester, P.c. edward Ament M.d. White Plains, ny c-M
gastroenterology
Mount Kisco Medical group Putman hospital center office endo suite
Abe levy M.d.
carmel, ny
c-M
gastroenterology
Advanced gastroenterology/endoscopy PcAli s. Karakurum M.d.
Port Jefferson, ny c-M
gastroenterology
the hunstad center for cosmetic Plastic surgery, P.A.
Joseph P. hunstad M.d., f.A.c.s.
huntersville, nc c
Plastic surgery
Zwanger Pesiri Radiology llP
steven l. Mendelsohn M.d.
east setauket, ny c-M
diagnostic Radiology
Zwanger Pesiri Radiology llP
steven l. Mendelsohn M.d. Medford, ny
c-M
diagnostic Radiology
columbia university skin and laser center Monica l. halem M.d.
new york, ny
b
dermatology
east side endoscopy llc
brett bernstein M.d.
new york, ny
c-M
gastroenterology
surgistar, lP
John d. Wallace d.d.s., M.d.
dallas, tX
c
oral & Maxillofacial surgery
twin Rivers gastroenterology llP
david h. brody M.d.
Port Jervis, ny
c-M
gastroenterology
Plastic surgery center of the carolinas
terrance W. bruner M.d. spartanburg, sc c
Plastic surgery
innovative care center
gregory e. Rauscher M.d. hackensack, nJ A
Plastic surgery
gastroenterology and nutrition, P.c.
samuel davidoff M.d.
forest hills, ny c-M
gastroenterology
Aster obgyn, P.c.
farris fahmy M.d.
new york, ny
b
obstetrics & gynecology
neuro Pain consultants
James honet M.d.
bloomfield hills, Mi c-M
Pain Medicine
neuro Pain consultants
James honet M.d.
clarkston, Mi
c-M
Pain Medicine
the gastro surgi center of new Jersey, llc Marvin lipsky M.d.
Mountainside, nJ c
gastroenterology
osteon surgery center
edwin haronian M.d.
encino, cA
c
Multi-specialty
Women's health care, P.c.
Marshall howell M.d.
newburgh, in
b
obstetrics & gynecology
newport coast surgical institute
luu Q. doan M.d.
huntington beach, cA c
Plastic surgery
Palm beach Plastic surgery
david Rankin M.d.
Jupiter, fl
c
Plastic surgery
galleria Pain Management suite, P.c.
sanjay bakshi M.d.
new york, ny
c-M
Pain Medicine
gastroenterology specialists, P.c. / east Valley endoscopy
John Papp, Jr. M.d. grand Rapids, Mi
c-M
gastroenterology
Plastic surgery center of nc, inc.
John A. fagg M.d.
Winston-salem, nc
c
Plastic surgery
oak tree surgical center, llc
sharam daneshgar M.d.
thousand oaks, cA
c-M
gastroenterology
long island Magnetic Resonance imaging, Pc, long island Medical imaging, Pc, long island Medical diagnostic imaging, Pc,
dba Zilkha Radiology
Albert Zilkha M.d.
east islip, ny
c-M
Radiology
13
10-348 ASF_SummerFall2010:10-348 AAAASF 9/16/10 9:21 AM Page 14
SURGICAL SAFETY CHECKLIST (FIRST EDITION)
Before induction of anaesthesia
SIGN IN
PATIENT HAS CONFIRMED
• IDENTITY
• SITE
• PROCEDURE
• CONSENT
Before skin incision
TIME OUT
PULSE OXIMETER ON PATIENT AND FUNCTIONING
ANTICIPATED CRITICAL EVENTS
DOES PATIENT HAVE A:
SURGEON REVIEWS: WHAT ARE THE
CRITICAL OR UNEXPECTED STEPS,
OPERATIVE DURATION, ANTICIPATED
BLOOD LOSS?
DIFFICULT AIRWAY/ASPIRATION RISK?
NO
YES, AND EQUIPMENT/ASSISTANCE AVAILABLE
RISK OF >500ML BLOOD LOSS
(7ML/KG IN CHILDREN)?
NO
YES, AND ADEQUATE INTRAVENOUS ACCESS
AND FLUIDS PLANNED
NURSE VERBALLY CONFIRMS WITH THE
TEAM:
THE NAME OF THE PROCEDURE RECORDED
ANAESTHESIA SAFETY CHECK COMPLETED
KNOWN ALLERGY?
NO
YES
SIGN OUT
CONFIRM ALL TEAM MEMBERS HAVE
INTRODUCED THEMSELVES BY NAME AND
ROLE
SURGEON, ANAESTHESIA PROFESSIONAL
AND NURSE VERBALLY CONFIRM
• PATIENT
• SITE
• PROCEDURE
SITE MARKED/NOT APPLICABLE
Before patient leaves operating room
ANAESTHESIA TEAM REVIEWS: ARE THERE
ANY PATIENT-SPECIFIC CONCERNS?
THAT INSTRUMENT, SPONGE AND NEEDLE
COUNTS ARE CORRECT (OR NOT
APPLICABLE)
HOW THE SPECIMEN IS LABELLED
(INCLUDING PATIENT NAME)
WHETHER THERE ARE ANY EQUIPMENT
PROBLEMS TO BE ADDRESSED
SURGEON, ANAESTHESIA PROFESSIONAL
AND NURSE REVIEW THE KEY CONCERNS
FOR RECOVERY AND MANAGEMENT
OF THIS PATIENT
NURSING TEAM REVIEWS: HAS STERILITY
(INCLUDING INDICATOR RESULTS) BEEN
CONFIRMED? ARE THERE EQUIPMENT
ISSUES OR ANY CONCERNS?
HAS ANTIBIOTIC PROPHYLAXIS BEEN GIVEN
WITHIN THE LAST 60 MINUTES?
YES
NOT APPLICABLE
IS ESSENTIAL IMAGING DISPLAYED?
YES
NOT APPLICABLE
THIS CHECKLIST IS NOT INTENDED TO BE COMPREHENSIVE. ADDITIONS AND MODIFICATIONS TO FIT LOCAL PRACTICE ARE ENCOURAGED.
AORN Ambulatory Surgery Center Infection Prevention Course Available
this course provides Ambulatory surgery center (Asc) staff and administrators with information that will assist them in meeting cMs
requirements for infection prevention control programs in ambulatory surgery centers.
the four module course follows the cMs surveyor worksheet, focusing on the observations and assessments that will be made during
an accreditation visit to your Asc.
in addition to collecting information about how your Asc provides services such as anesthesia, environmental cleaning, linen, nursing, pharmacy, sterilization, reprocessing and waste management, the surveyor will make a determination on the basis and scope of
your infection control program.
the four modules of this course contain rationale and supporting evidence for the parameters of a successful infection control program.
* Module one covers sterilization and high level disinfection. it also includes a section on reprocessing of single use devices.
* Module two covers hand hygiene practices including monitoring and suggestions to improve compliance.
* Module three is focused on critical environmental infection control practices.
* Module four is devoted to practices related to point-of-care devices and injection practices.
the course should be used by all Ascs who want to ensure that they have implemented a quality infection control program that
results in safe patient outcomes. the course is appropriate for all staff, administrators and physicians who provide services in the Asc
setting.
students will have four (4) months to complete the course. this course is worth 6.8 contact hours. to earn the contact hours and print
a certificate you must complete all the course modules and the final course evaluation. your record will be updated with your contact
hours the month following the completion of the course.
14
10-348 ASF_SummerFall2010:10-348 AAAASF 9/16/10 9:21 AM Page 15
ASF Source Newsletter Submission Deadlines/Rates
For Articles, Advertising and Photos - Winter 2010 Issue Deadline - October 30th, 2010
Articles on patient safety issues and quality care practices within the outpatient surgery environment
are accepted any time throughout the year. Please email your articles or ideas for articles to Jaime
trevino, communications director at [email protected] and you will be notified if the Publications
committee decides to use your article.
ASF Source Advertising 2010 Rates
cAMeRA ReAdy
b/W
sPot coloR
4/coloR
full page
$700
$825
$1,350
1/2 page
$450
$625
$850
1/4 page
$225
$425
$550
1/8 page
$110
$325
$450
Interested in Serving on an AAAASF Committee?
We are also interested in getting more nurses and younger surgeons from our accredited facilities involved in all our committees in order to broaden our perspectives, get new ideas, and develop future leaders of the Association. if you are interested in participating on a committee, please complete this form and
mail/fax to: aaaasf office - fax: 847-775-1985 P.o. boX 9500 • 5101 Washington street, suite 2f • gurnee, il 60031
name and title: _______________________________________________________________________________years in Practice: __________
AAAAsf facility name or #: ______________________________________________________________________________________________
Address:_________________________________city:_____________________state:____Zip:___________telephone: __________________
fax:______________________e-mail:_____________________________________________________________________________________
check the box next to the committee that you are interested in:
if selected, you will be contacted by AAAAsf staff. thank you for your interest in serving as an AAAAsf committee member!
standards
technology
Reimbursement
education
legislative
Publications
investigative
inspectors
Accreditation
QA/Peer Review
Request for a Newsletter
if you wish to be included on our mailing list or you know of a medical specialist that
has requested to be included, please complete this form and fax or mail to the
AAAAsf office.
name
________________________________________________________________________________________
title or specialty
________________________________________________________________________________________
facility name
________________________________________________________________________________________
facility Address
________________________________________________________________________________________
telephone
________________________________________________________________________________________
fax
________________________________________________________________________________________
e-mail
fax to: 847-775-1985 or email all required information to: [email protected]
15
10-348 ASF_SummerFall2010:10-348 AAAASF 9/16/10 9:21 AM Page 16
PRSRT STD
U.S. POSTAGE
PAID
PERMIT NO. 195
LIBERTYVILLE, IL
P.o. boX 9500
gurnee, il 60031
1-888-545-5222 (toll free)
847-775-1970
fax: 847-775-1985
ASF Source News You Can Use
As proponents of Malignant Hyperthermia education, US WorldMeds, the makers of generic dantrolene sodium
for injection, offer several value-added services including in-servicing vials and free online MH Training. Please
visit: www.ds-iv.com/resources.htm for more information.
specialists
1-2
3-5
3-5
6-9
6-9
10
10
aNNUaL fEEs for rEgULar aCCrEDITaTIoN
CLass
specialties
a
B, C, C-M
1 - 2 specialties
$750
$1,105
1 - 2 specialties
$1,045
$1,545
3 or more specialties
$1,325
$1,820
1 - 2 specialties
$3,390
$4,100
3 or more specialties
$3,655
$4,360
1 - 2 specialties
$4,785
$6,045
3 or more specialties
$5,045
$6,885
specialists
1-2
3-5
3-5
6-9
6-9
10
10
aNNUaL fEEs for MEDICarE CErTIfICaTIoN
CLass
specialties
B, C
1 - 2 specialties
$1,655
1 - 2 specialties
$2,095
3 or more specialties
$2,370
1 - 2 specialties
$4,625
3 or more specialties
$4,885
1 - 2 specialties
$6,570
3 or more specialties
$7,410
inspection fees: $500 for *new facility (*new facility refers to a brand new location where no cases
have been performed, this inspection is required in florida, california and new york for all facilities
that currently do not hold state licensure or other accreditation at the time of application.), as well as
$950 for regular or $2150 for Medicare inspections in addition to the annual fee schedule.